What could PACS vendors do better in order to meet the needs of end users?

Purchasing a PACS can be a daunting task. PACS and informatics experts reveal their own wish lists of ways PACS vendors could make the decision easier.

Dr. Frits Barneveld Binkhuysen
Radiologist, Hospital Eemland
Amersfoort, the Netherlands

One of the most important aspects is honesty. What do I mean? At first glance, different vendors' PACS look much alike. A closer look, however, can reveal a wide range of functionality. Clients often find it hard to see the essential differences. PACS vendors must be honest about what the latest version of their system can do and, perhaps more important, what is not possible. Accurate information on what to expect from future upgrades is also important.

This information must be related to general trends in PACS; for example, the move toward Web-based viewing. Is your PACS vendor following these trends? If you buy a conventional viewing station now, can it be replaced by a Web-based workstation next year, and at what cost? PACS vendors must make it clear what they cannot deliver.

Dr. Erik Ranschaert
Radiologist, Jeroen Bosch Ziekenhuis, locatie Carolus
's-Hertogenbosch, The Netherlands

Including mammography in a PACS is an ongoing problem, and few vendors know the answer. We started with 1K monitors and used a computed radiography (CR) system with high-resolution (100 microns/pixel) cassettes to generate mammograms. But comparison with conventional films showed that some microcalcifications were invisible on CR. We then switched to a CR-reader with a 50 microns/pixel resolution and invested in a dedicated diagnostic workstation for mammography with 5K monitors. The quality of our mammograms is now as good, or even better, than conventional mammography. But our PACS vendor did not suggest that we purchase a dedicated mammography workstation. We had to find this out for ourselves.

We have learned from calculations that digital radiography (DR) is not a prerequisite to going filmless. Vendors should discourage hospitals and radiology departments from waiting for DR before installing a PACS. DR is still too expensive and does not improve workflow/throughput significantly. CR remains a better investment because it is affordable and does improve workflow, so long as the technology is implemented correctly. Radiographers should not have to run through the entire department to process their cassettes.

Prof. Walter Hruby
Chair of radiology
Danube Hospital, Vienna

PACS vendors need to ask end users what they need and also what they don't need. Although this statement appears self-evident, end users are rarely involved in decision-making processes and are seldom asked about their workflow needs. In most cases, end users' suggestions have to travel bottom-up through their department and then top-down through company hierarchy until their recommendations reach a software engineer. PACS vendors, and especially their software engineers, should spend much more time in radiology departments, observing and talking to radiologists, radiographers, and transcriptionists. They may discover that most end users don't want added functionality and would prefer their PACS to deliver simplified workflow processes.

Dr. Keith Foord
Consultant radiologist
Conquest Hospital, Hastings, U.K.

Vendors should subscribe fully to the Integrating the Healthcare Enterprise (IHE) initiative, be flexible with respect to third-party products, and not resell standard hardware at a premium price. They should be moving to supplying and supporting the customer's choice of software and hardware products. If the prospective purchaser likes reporting workstations from vendor A, the Web view product offered by vendor B, the RIS of vendor C, and vendor D's archiving solution, that is what he/she should be able to buy and have supported in a no-blame environment.

Dr. Raimund Vogl
Imaging information manager
Innsbruck Hospital, Austria

PACS software solutions have matured considerably over the last three or four years. Most modern PACS solutions should provide an efficient working environment in terms of performance, functionality, and usability, if they are deployed properly. For a successful project with optimum utilization of all features, the vendor must have a well-trained, highly motivated implementation team, whose members are willing to analyze the peculiarities of each specific site and who will strive to provide a well-integrated solution according to users' needs.
A PACS is not "plug-and-play" technology. Vendors cannot simply deliver the system, set it up, provide two days of training, and then leave the customer all alone. A PACS is a set of tools, which can be assembled into a working system for optimum benefit after careful analysis. Vendors should pay more attention to this aspect of systems integration.

Dr. Davide Caramella
Associate professor of radiology
University of Pisa, Italy

Companies should appreciate that when installing a new system in a hospital, rather than acting as vendors they should become actual "partners" of their customers. This is particularly important in order to avoid "surprises" in the financial field, in the implementation schedule, in the standard compliance issues, and in the maintenance aspects. Every detail should be addressed honestly beforehand, without hiding relevant data or minimizing possible future problems. This may have a negative impact on the short-term revenues of the companies, but it will eventually permit them to stay in the market as reliable and respected players.